입원 노인환자의 의약품 사용과 낙상위험도 연구

Medication use as a Risk Factor for Falls in Hospitalized Elderly Patients in Korea

  • 이유정 (숙명여자대학교 임상약학대학원)
  • Lee, Yu-Jeung (Graduate School of Clinical Pharmacy, Sookmyung Women's University)
  • 투고 : 2011.07.12
  • 심사 : 2011.09.30
  • 발행 : 2011.09.30

초록

낙상은 노인의 건강을 위협하는 가장 심각한 문제 중의 하나이며, 조기사망, 신체손상, 운동장애, 심리학적 기능장애를 유발하는 원인이기도 하다. 본 연구의 목적은 국내 노인전문 요양병원 입원 환자들의 의약품 사용이 낙상에 미치는 영향을 평가하는데 있다. 후향적으로 원내 의무기록 정보를 이용하여 환자-대조군 연구를 수행하였고, 2008년 1월부터 2010년 12월까지 3년 기간에 입원한 65세 이상을 대상으로 하였다. 입원기간 중 낙상을 경험한 34명의 노인환자들을 환자군으로 선택하였으며 낙상을 경험하지 않은 68명의 노인환자들을 무작위 추출하여 1:2의 환자군:대조군비율로 연구 대상 환자들을 선정하였다. 환자군이 복용한 의약품을 대조군이 복용한 의약품과 비교하였으며 각 계열별 의약품과 낙상위험도 관계를 평가하였다. 두 그룹간의 인구통계학적 특성은 유사하였고 연령, 성별, 복용 의약품수, 고혈압 유무, 혈중 크레아티닌 수치, 혈중 나트륨 수치, 혈압 또는 심박수에 유의한 차이는 없었다. 항히스타민제와 본 연구에서 유일하게 기타 수면보조제로 분류된 졸피뎀이 유의하게 낙상위험도를 증가시켰다.

키워드

참고문헌

  1. Poster EC, Pelletier LR, Kay K. A retrospective cohort study of falls in a psychiatric inpatient setting. Hosp Community Psychiatry 1991; 42: 714-720.
  2. Peterson JF, Kuperman GJ, Shek C, et al., Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med 2005; 165: 802-807. https://doi.org/10.1001/archinte.165.7.802
  3. Flament MF, Lane RM, Zhu R, et al., Predictors of an acute antidepressant response to fluoxetine and sertraline. Int Clin Psychopharmacol 1999; 14: 259-275. https://doi.org/10.1097/00004850-199914050-00001
  4. Halfon P, Eggli Y. Screening inappropriate hospital days on the basis of routinely available data. Int J Qual Health Care 2001; 13: 289-299. https://doi.org/10.1093/intqhc/13.4.289
  5. Hitcho EB, Krauss MJ, Birge S, et al., Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med 2004; 19: 732- 739. https://doi.org/10.1111/j.1525-1497.2004.30387.x
  6. Greene E, Cunningham CJ, Eustace A, et al., Recurrent falls are associated with increased length of stay in elderly psychiatric inpatients. Int J Geriatr Psychiatry 2001; 16: 965-968. https://doi.org/10.1002/gps.463
  7. Bates DW, Pruess K, Souney P, et al., Serious falls in hospitalized patients: correlates and resource utilization. Am J Med 1995; 99: 137-143. https://doi.org/10.1016/S0002-9343(99)80133-8
  8. Vassallo DJ, Rowlands PC. A novel way of taking trauma radiographs of a stretcher patient in a field hospital. J R Army Med Corps 2002; 148: 138-139. https://doi.org/10.1136/jramc-148-02-06
  9. Salgado RI, Lord SR, Ehrlich F, et al., Predictors of falling in elderly hospital patients. Arch Gerontol Geriatr 2004; 38: 213-219. https://doi.org/10.1016/j.archger.2003.10.002
  10. Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003; 348: 42-49. https://doi.org/10.1056/NEJMcp020719
  11. Krauss MJ, Evanoff B, Hitcho E, et al., A case-control study of patient, medication, and care-related risk factors for inpatient falls. J Gen Intern Med 2005; 20: 116-122. https://doi.org/10.1111/j.1525-1497.2005.40171.x
  12. Bueno-Cavanillas A, Padilla-Ruiz F, Jimenez-Moleon JJ, et al., Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 2000; 16: 849-859. https://doi.org/10.1023/A:1007636531965
  13. Cumming RG, Klineberg RJ. Psychotropics, thiazide diuretics and hip fractures in the elderly. Med J Aust 1993; 158: 414-417.
  14. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999; 47: 40-50. https://doi.org/10.1111/j.1532-5415.1999.tb01899.x
  15. Liu B, Anderson G, Mittmann N, et al., Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998; 351: 1303-1307. https://doi.org/10.1016/S0140-6736(97)09528-7
  16. Thapa PB, Gideon P, Cost TW, et al., Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998; 339: 875-882. https://doi.org/10.1056/NEJM199809243391303
  17. Passaro A, Volpato S, Romagnoni F, et al., Benzodiazepines with different half-life and falling in a hospitalized population: The GIFA study. Gruppo Italiano di Farmacovigilanza nell'Anziano. J Clin Epidemiol 2000; 53: 1222-1229. https://doi.org/10.1016/S0895-4356(00)00254-7
  18. Gales BJ, Menard SM. Relationship between the administration of selected medications and falls in hospitalized elderly patients. Ann Pharmacother 1995; 29: 354-358. https://doi.org/10.1177/106002809502900402
  19. Ziere G, Dieleman JP, Hofman A, et al., Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006; 61: 218-223. https://doi.org/10.1111/j.1365-2125.2005.02543.x
  20. Neutel CI, Perry S, Maxwell C. Medication use and risk of falls. Pharmacoepidemiol Drug Saf 2002; 11: 97-104. https://doi.org/10.1002/pds.686
  21. Wang PS, Bohn RL, Glynn RJ, et al., Zolpidem use and hip fractures in older people. J Am Geriatr Soc 2001; 49: 1685-1690. https://doi.org/10.1111/j.1532-5415.2001.49280.x
  22. Chang CM, Chen MJ, Tsai CY, et al., Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study. Int J Geriatr Psychiatry 2011; 26: 602-607. https://doi.org/10.1002/gps.2569
  23. Campfield T, Bednarek FJ, Pappagallo M, et al., Nephrocalcinosis in premature infants: variability in ultrasound detection. J Perinatol 1999; 19: 498-500. https://doi.org/10.1038/sj.jp.7200263
  24. Sterke CS, Verhagen AP, van Beeck EF, et al., The influence of drug use on fall incidents among nursing home residents: a systematic review. Int Psychogeriatr 2008; 20: 890-910.
  25. Kallin K, Lundin-Olsson L, Jensen J, et al., Predisposing and precipitating factors for falls among older people in residential care. Public Health 2002; 116: 263-271. https://doi.org/10.1016/S0033-3506(02)90016-8
  26. Lee JS, Kwok T, Leung PC, et al., Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age Ageing 2006; 35: 246-251. https://doi.org/10.1093/ageing/afj056
  27. Pariente A, Dartigues JF, Benichou J, et al., Benzodiazepines and injurious falls in community dwelling elders. Drugs Aging 2008; 25: 61-70. https://doi.org/10.2165/00002512-200825010-00007
  28. Dorn J, Masciotra S, Yang C, et al., Analysis of genetic variability within the immunodominant epitopes of envelope gp41 from human immunodeficiency virus type 1 (HIV-1) group M and its impact on HIV-1 antibody detection. J Clin Microbiol 2000; 38: 773-780.
  29. Sorock GS, Shimkin EE. Benzodiazepine sedatives and the risk of falling in a community-dwelling elderly cohort. Arch Intern Med 1988; 148: 2441-2444. https://doi.org/10.1001/archinte.1988.00380110083017
  30. Goodwin JS, Regan M. Cognitive dysfunction associated with naproxen and ibuprofen in the elderly. Arthritis Rheum Aug 1982; 25: 1013-1015. https://doi.org/10.1002/art.1780250817
  31. Lin HJ, Yip PK, Liu HM, et al., Noninvasive hemodynamic classification of carotid-cavernous sinus fistulas by duplex carotid sonography. J Ultrasound Med 1994; 13: 105-113. https://doi.org/10.7863/jum.1994.13.2.105